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ENT Flashcards

1
Q

define acoustic neuroma

A

benign tumours of Schwann cells surrounding vestibulocochlear nerve,

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2
Q

acoustic neuroma, aka (x2)

A

vestibular schwannoma
*cerebellopontine angle tumours

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3
Q

acoustic neuroma presentation
- bi or unilateral?
- age group
- may be associated with what palsy?
- 4main symptoms

A

Typically unilateral. (Bilateral =ass. w/ neurofibromatosis type II).

Aged 40-60 years

facial nerve (CNVII) palsy

  • Gradual onset of:
    o Unilateral sensorineural hearing loss (often the first symptom)
    o Unilateral tinnitus
    o Dizziness or imbalance
    o A sensation of fullness in the ear
    *
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4
Q

BPPV
Dx manouvre
Mx manaouvre

A

Dx- Dix-hallpike
Mx - Epsley

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5
Q

BPPV
give 2
- Sx associated with the vertigo
- Sx NOT associated with the vertigo

A
  • Triggered by head movement
  • symptoms last 20-60s

not ass/ w/
- hearing loss
- tinnitus

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6
Q

comonly associated cause of epiglottitis

A

Haemophilus influenzae b (Hib) - reduced since vaccines

Other causes are: Infectious (Streptococcus spp, Staph aureus, Pseudomonas, Herpes simplex) or Non-infectious (Thermal, foreign bodies, radiotherapy)

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7
Q

key differential Sx of epiglotitis (x4)

A

high temperature, inspiratory stridor, difficulty breathing, drooling, and irritability.

differentials :
croup: barking cough & coryzal w/inspiratory stridor in moderate/severe cases. Sx worse at night.

Bacterial Tracheitis: Sx intermediary between croup and epiglottitis, (difficulty breathing, SOB, High temp)

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8
Q

2 steps in managing epiglottitis

A

1 Nebulised adrenaline and IV dexamethasone ) reduce mucosal oedema)
2 If medical mx unsuccessful – intubate to get definitive airway

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9
Q

acute unilateral vertigo lasting 15 hours. With ipsilateral dulling of hearing.
It began suddenly, no obvious trigger, while sat on the sofa.
Can hear a faint buzzing in the ear and feels nauseous.
Hx: mild viral illness one week earlier.
Exam: CN intact. Otoscopy:translucent tympanic membrane with normal ossicles and no effusion. What is the most likely diagnosis?

A

Acute labrynthitis

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10
Q

In BPPV, what type of nystagmus is seen in Dix-hallpike manouevre

A

rotatory nystagmus

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11
Q

what is the most likely location of bleeding in epistaxis>

A

Littles area ( comtains Kiesselbachs plexus, where belled comes form

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12
Q

Give 10 causes of epistaxis

A
  • Nose picking
  • Colds
  • Sinusitis
  • Vigorous nose-blowing
  • Trauma
  • Changes in the weather
  • Coagulation disorders (e.g., thrombocytopenia or Von Willebrand disease)
  • Anticoagulant medication (e.g., aspirin, DOACs or warfarin)
  • Snorting cocaine
  • Tumours (e.g., squamous cell carcinoma)
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13
Q

4 reasions to admit patient with epstaxis

A

o bleeding >10 – 15 minutes,
o sesvere bleed
o bilateral bleed
o haemodynamically unstable

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14
Q

Mx eistaxis ( acute x 2, post-event )

A

acute:
nasal packing
nasal cautery

Naseptin nasal cream QDS 10/7 (reduces crusting, inflammation and infection)

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15
Q

Give 3 other names for glandular fever

A

kissing disease
infectious monocnucleosis
mono

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16
Q

typical infectious monocnucleosis Sx in :
- childhood
- teen/adulthood

A

childhood - minimal Sx
teen/adult: fever, sore throat, fatigue

other: * Lymphadenopathy (swollen lymph nodes)
* Tonsillar enlargement
* Splenomegaly & splenic rupture (rare)

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17
Q

name 2 tests used in EBV Dx

A

Heterophile Ab teat ( Monospot test / Paul-Bunnell test

Viral capsid antigen test ( specific EBV Ab)

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18
Q

EBV Mx

A

condition is self-imiting, lasts 2-3 weeks

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19
Q

what shoud patiets with EBV avoid ( x3)

A

Alcohol
Contact sports
Ammoxicillin/cephalosporin

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20
Q

x6 complications of EBV

A
  • Splenic rupture
  • Glomerulonephritis
  • Haemolytic anaemia
  • Thrombocytopenia
  • Chronic fatigue
  • Increased cancer risk e.g., Burkitt’s lymphoma.
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21
Q

menieres triad

A
  • Hearing loss
  • Vertigo
  • Tinnitus
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22
Q

typical menieres presentation

A

40-50 years old,
unilateral UNILATERAl vertigo (20mins-hrs, not triggered by mvtm), hearing loss (fluctuating, ass.w/ vertigo, then permanent), and tinnitus (gradually becomes permmanent

also
* A sensation of fullness in the ear
* Unexplained falls (“drop attacks”) without loss of consciousness.
* Imbalance (can persist after episodes of vertigo resolve

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23
Q

Dx Ix for menieres

A

audiooogy assessment

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24
Q

menieres Mx
acute x2
prophylaxis x 1

A

For acute attacks
short-term:
* Prochlorperazine
* Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Prophylaxis:
* Betahistine

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25
OSA define 5x risk factors
def: collapse of the pharyngeal airway characterised by episodes of apnoea during sleep RF: * Middle age * Male * Obesity * Alcohol * Smoking
26
OSA Mx 1 who to refer 2 1st-3rd line Mx
Management * ENT specialist / specialist sleep clinic * 1st step: correct reversible risk factors: weightloss, stop alcohol, stop smoking * 2nd: CPAP * 3rd Surgery: reconstruction of the soft palate and jaw.
27
give 5 causes of otitis externa
Bacteria ( pseudomonas aeruginosa, staph. aureus) fungal ( aspergillus, candida) eczema sebhorrhoeic dermatitis contact dermatitis
28
the stages of otitis externa and the management
mild - acetic acid mod - topical abx & steroid *(e.g. otomize spray - neomycine+dex+acetic acid) sev: oral abx, ear wick before ear drops/soray , clotrrimozole malignant: Adx, IV Abx & MRI/CT for assessing extent of infeciton
29
4 causes of otitis media
most common - strep. pneumonia also: H. influenzae, M. catarrhalis, Staph. aureus (bacterial inflection often preceded by viral URTI)
30
the 1st line meds for otitis media
Amoxicillin 5-7 days if allergic: clarithromycin if allergic & pregnant: erythromycin
31
sinusitis vs rhinosinusitis
rhinosinusitis = sinusitis (imnflammed paranasal siniuses) combined with infammation of nasal cavity
32
how does sinusitois occur
normally: sinuses is where mucous is produced and this drains into the ostia blocked ostia --> no drainage --> sinusitis
33
name the paranasal sinuses
frontal sinuses (above eyebrows) maxillary sinuses )either soide of nose, the largest) ethmoid sinuses (in ethmoid bone, mid nasal cav ity) sphenoid sinuses (sphenoid bone, back of nasal cavity
34
acute sinusitis Mx - Sx for <10 days - Sx for >10 days (x2)
no Rx - resolves in 2-3wks if viral Mometasone 200mcg BD 14days (high dose steroid nasal spray Delayed Rx ABx (phenoxymethylpenicillin 1st line)
35
Mx Chronic sinusitis x3
nasal irrigation nasal spray/drop (mometasone/fluticasone FESS (Functional endoscopic suinus surgery)
36
most common cause of tonsillitis
viral
37
most common bacterial cause of tonsillitis
GAS (strep pyogenes) or strep pneumoniae other common bact. causes are same as in otitis media (h.influenza, M.catharrhalis, Staph. aureus
38
what name describes the tonsil ring how many areas of tonsil tissue are there? Name them which of them is typically enlarged in tonsillitis
Waldeyer's tonsillar ring = 6 areas of limphoid tissue adenoid, x2 tubal, x2 palatine, lingual palatine
39
when would you Rx Abx in tonsillitis? (x3)
1. Centor score >/= 3 2. FeverPAIN >/=4 3. high risk for infection
40
1st line Tx in tonsillitis
Penecillin V )(phenoxymethylpenecillin/ clarithromycin (if allergic)
41
give 7 complications of tonisllitis
chronic tonsillitis Wuinsy Otitis media scarlet fever rhematic fever post-strep glomerulonephritis post-strep ReA
42
give 4 main causes of peripheral vertigo
BPPV Menieres labrynthitis vestiibular nueronitis
43
give 4 central causes of vertigo
Posterior circulation infarction tumour MS vestibular migraine (central vertigo = sustained, non-positional vertigo)
44
name the 4 types of exams to conduct in vertigo
ear (?infection) neuro (inc cerebellar exam - danish) CV exam Special tests - rombergs, dix-hall-pike, HINTS
45
Mx peripheralvertigo - 2 groups meds - menieres prophylaxis - DVLA instructions
Short term Mx in peripheral : Prochlorperazine/ antihistmisn (cyclizine, cinnarizine, promethazine) Menieres prophylaxis - betahistine DVLA - do not drive, inform DVLAA if liable to " sudden, unprovoked episodes of disablign dizziness"
46
does vestibular neuronitis affect tinnitus hearing
no, as cochlea/cochlear nerve are not affected
47
3 Sx of vestibular neuronitis
vertigo ( most sivere for 1st ew days nausea & vom , and balance problems
48
Examination ofr vestibular neuronitis
head impulse test
49
Mx in vestibular neuronitis - when to afmit - the short term Mx options
Adx ( in dehydration from N&V) short term ( 3days) prochlorperazine/ antihistamines (cyclizine, cinnariziene, promethazine)
50
prognosis of vestibular neuronitis (x2)
most severe st few days, slowly resolves over 2-6 weeks may develop into BPPV
51
Short term Sx (vertigo) options in labyrinthitis/vestibular neuronitis/ menieres ) How long can these be prescribed for in vertigo?
Prochlorperazine antihistamines ( cyclizine, cinnarizine, promethazine) max 3 days
52
what differentiates labrythithisis fro vestuiiular neuronitis
similarities - acute onset vertigo ( esp followign viral URTI) difference Labryinthitis - Loss of hearing, and tinnitus
53
what differentiates labrythithisis fro vestuiiular neuronitis
similarities - acute onset vertigo ( esp followign viral URTI) difference Labryinthitis - Loss of hearing, and tinnitus
54
primary tinnitus - what causes it? - what Sx is it associated with (not tinnitus)
cause: no identifiable cause Sx: sensorineural hearing loss
55
name 3 drugs associated with secondary tinnitus
secondary tinnitus - tinitus w/ associated cause meds: loop diuretics, gentamicin, chemo drugs (cisplatin)
56
give 4 ENT & 4 systemic conditions associated with tinnitus
ENT - Ear infection acoustic neuroma, menieres, (MS) Systemic - anaemia, diabetes, Hypo/hyperthyroid, hyperlipidaeimaia
57
additional sounds causing objective tinnitus pulsatile carotid bruit
carotid artery stenosis
58
additional sounds causing objective tinnitus radiating pulsatile murmur sounds
aortic stenosis
59
additional sounds causing objective tinnitus pulsatile
arteriovenous malformations
60
additional sounds causing objective tinnitus popping/clicking noises
eustachian tube dysfunction
61
5 mx options for tinnitus
- improves/ resolves over time w/o interventions. - Tx Underlying causes (e.g., ear wax/infection). * Hearing aids * Sound therapy (adding background noise to mask the tinnitus) * CBT
62
What are indications for hospital admission in Tonsillitis
Systemically unwell child Dehydration Suggestion of airway compromise
63
Cholesteatoma - what is it -What is the cause
Cause: recurrent otitis Media
64
Mx in acute labyrinthitis
- self-limiting - Med: prochlorperazine or antihistamines (e.g. promethazine) for dizziness - can only be given for 3 days
65

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